Abstract

SESSION TYPE: Cancer Student/Resident Case Report Posters

PRESENTED ON: Tuesday, October 23, 2012 at 01:30 PM - 02:30 PM

INTRODUCTION: Mediastinal limited involvement in non-Hodgkin lymphoma is rare (about 5% of patients). The presence of endobronchial lesions occurs in less than 1% of cases, usually associated with spread from a mediastinal mass

CASE PRESENTATION: This is a 78 year old man with a history of smoking and chronic alcoholism without relevant medical history. He starts 6 months prior to admission with progressive dyspnea,present at rest at initial evaluation. He also refer dry cough, dysphagia and weight loss of 8 kg. On admission he is is tachycardic, polypneic, he has no fver, oxygen saturation 90% on room air. Physical examination is relevant by the presence of inspiratory and expiratory wheezing .Laboratory tests were within normal limits. On admission chest radiograph shows widening of the upper and middle mediastinum Chest CT is positive for the presence of adenopathies on anterior and posterior mediastinum, also in subcarinal lymph nodes associated with extrinsic compression on both main bronchi and the esophageal lumen. Bronchoscopy is performed, submucosal infiltration is observed in the carina. In the opening of the right superior lobe bronchus it is observed an exophytic mass. Biopsies of the tumor were taken. Pathology reports Large B Cell Non Hodgkin lymphoma. CHOP based chemotherapy was started

DISCUSSION: Endobronchial tree involvement is uncommon in Non hodgkin lymphoma, most frequently affecting main bronchi, lobar bronchi followed by lobar bronchi and trachea. Diverse mechanisms have been suggested for development of endobronchial lesions: 1) direct invasion of adjacent mediastinalor parenchymal lesions . 2) Lymphatic dissemination from peribronchial tissue. 3) transbronchial aspiration of tumor emboli Large B-cell lymphomas account for 20-25% of endobronchial NHL.Treatment of choice is based on CHOP combined with rituximab. Prognosis is good for endobronchial lymphoma (81% overall survival at 5 years) similar to other lymphomas with local presentation

CONCLUSIONS: Endobronchial NHL is an uncommon presentation with a favorable prognosis and good overall survival

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